MEDICARE: SHERRY M DELONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	2570R	OH

General Provider Information

NPI Number	:	1306573076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY M DELONG

Provider Business Mailing Address
First Line	:	650 SAINT CLAIR AVE
Second Line	:
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-3053
Country	:	US
Telephone Number	:	330-385-0700
Fax Number	:	330-386-1010

Provider Business Practice Location Address
First Line	:	650 SAINT CLAIR AVE
Second Line	:
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-3053
Country	:	US
Telephone Number	:	330-385-0700
Fax Number	:	330-386-1010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2022
Last Update Date	:	08/04/2022

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Directions to “ SHERRY M DELONG ” Practice Location

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